Case One Mrs. G. has an aneurysm in her brain that, if untreated by surgery, will lead to blindness and probably death.
In each case, answer the questions at the end of the case and
give researched references to support your assertions; also,
explain what would be the ethical course of action and the legal
requirements for action in the case. Case One Mrs. G. has an
aneurysm in her brain that, if untreated by surgery, will lead to
blindness and probably death. The surgery recommended leads to
death in 75% of all cases. Of those who survive the operation,
nearly 75% are crippled. Mrs. G has three small children. Her
husband has a modest job, and his health insurance will cover the
operation, but not the expenses that will result if she is
crippled. When informed of this, Mrs. G. is in great emotional
turmoil for a week or so until she makes her decision. She refuses
treatment, because she does not like the odds. There was, after
all, only a one chance out of sixteen for a real recovery. In
addition, she could not come to grips with exposing her family to
the risk of having a mother who would be a burden and not a help.
Can a patient with serious obligations, such as a family, refuse
treatment? What odds of recovery would be good odds? Case Two Mrs.
S., an 85-year-old housewife, becomes aware of breathlessness and
is easily fatigued. She is known to have had a heart murmur for 2
years. She consents to come to a research hospital for cardiac
catheterization, which confirms the presence of severe, calcific
aortic stenosis with secondary congestive heart failure. Because of
the unfavorable prospect for survival without surgical
intervention, the recommendation at the combined cardiac
medical-surgical conference is for an operation. The physician
explains the situation to Mr. and Mrs. S. and recommends aortic
valve replacement. It is noted that the risk of surgery is not well
known for Mrs. S,’s age group, and that early mortality is usually
around 10 percent, with 80 percent achieving good functional
results after 3 years. Her lack of an obvious disease makes her a
relatively good candidate for a successful surgical outcome,
despite her age. Mrs. S. appears to understand the discussion and
recommendation, but requests deferral of the decision and shows
signs of denial of the problem. She has no other medical problems,
her husband is in good health, and their marriage appears to be
happy. They are financially secure and enjoy a full set of social
and recreational activities. She returns on three subsequent
occasions for simple, supportive attention. The physician decides
not to employ psychiatric assistance or other measures to reduce
her denial and begins to use conversation to reduce her anxiety
associated with her decision. Does Mrs. S.’s apparent denial of her
condition make informed consent impossible? Is the physician
ethical in reducing her anxiety about her apparent refusal of
treatment when the physician believes treatment is medically
indicated?
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